This page exists because a tongue tie assessment should be able to conclude that a child does not have a problem we can fix — and to say where the actual answer lies.
Tongue tie has become a widely discussed explanation for feeding difficulty, disturbed sleep, mouth breathing, speech problems and crowded teeth. It genuinely can contribute to all of those. But it is not the only thing that can, and treating it as the default explanation leads to children having procedures that were never going to help them.
The thing that matters is tongue posture, not the frenulum
Much of what people attribute to tongue tie comes back to one thing: whether the tongue can sit comfortably up against the roof of the mouth at rest.
A tongue that rests on the palate supports how the mouth works and, over time, is one of the influences on how the upper arch develops. A tongue that spends its time sitting low does not.
A tongue tie is one reason a tongue might not rest there. It is not the only one.
Other reasons a tongue may not rest on the palate
Enlarged adenoids or tonsils. If the nasal airway is obstructed, a child will breathe through the mouth, and a mouth-breathing child cannot rest the tongue on the palate — the mouth is open. This is common and frequently the actual driver.
Chronic nasal congestion and allergies. Allergic rhinitis and persistent congestion produce the same result for the same reason.
Low muscle tone. Where general tone is low, oral tone often is too, and the tongue may simply not hold a raised resting posture. That is a different problem from a physical restriction, and it needs a different approach.
The structure of the palate itself. A high or narrow vault changes what resting on it involves.
Neurological and developmental differences. These can affect oral motor function in ways that have nothing to do with a frenulum.
Habits. Prolonged thumb or dummy use can influence oral posture and arch shape.
Often it is more than one of these at once. A child can have a genuine restriction and enlarged adenoids, and releasing the restriction while ignoring the airway will not achieve much.
Why this matters practically
If your child is mouth breathing because of enlarged adenoids, what they need is an ENT opinion. A dental procedure will not open their nose.
If your child has low oral tone, they need therapy to build function. Releasing something that was not restricting them adds a procedure without adding a benefit.
If allergies are keeping the nose blocked, that is a medical question first.
Working out which of these is actually driving things is a substantial part of what a functional assessment is for. It is at least as important as identifying a tie — arguably more so, because getting it wrong sends a family down a pathway that cannot help.
How we work out which it is
Assessment with Dr Helen Fung looks at function, not just anatomy: what the tongue can actually do, what it does at rest, and whether a physical restriction is limiting it — including gentle palpation, since some restrictions cannot be seen.
But it also looks wider. How does your child breathe, during the day and at night? How do they sleep? Is the nose usually clear? What does the palate look like? What have other professionals already noticed?
If the picture points somewhere else, we will say so, and help you work out who to see. We work regularly alongside ENT surgeons, paediatricians, lactation consultants, speech pathologists, occupational therapists and myofunctional therapists — and we would much rather send you to the right person than treat the wrong thing.
A word about the wider conversation
It is worth being straightforward about the state of this field.
Understanding of tongue restriction is still developing. In some areas enthusiasm has run ahead of the evidence, and rates of surgery in some communities are difficult to justify. Healthy scepticism is not an obstacle to good diagnosis — it is part of it.
At the same time, doing nothing is not automatically the safe option. Where a child genuinely has a functional problem, watching and waiting without any support is also a choice, and it has consequences.
The position we try to hold is neither of the extremes: careful assessment driven by function, conservative decisions, working with other professionals, and honest conversations with families — including the conversation where the answer is “not this”.
If you have been told your child has a tongue tie
You are welcome to seek a second opinion, and you should not feel awkward about it.
A useful assessment should be able to tell you what the tongue can and cannot do, whether a restriction is genuinely responsible, what else might be contributing, and what would happen if you did nothing. If you have not been given those four answers, they are reasonable to ask for.
Common questions
My child mouth breathes — is that a tongue tie?
It may be one factor, but enlarged adenoids, nasal congestion and allergies are common causes. Mouth breathing always has a cause and finding the right one matters.
Can my child have both a tongue tie and something else?
Yes, and it is common. Addressing only one of them often does not achieve much.
Would you tell us if it isn’t a tongue tie?
Yes. That is a normal and useful outcome of an assessment, and we will help you work out who to see next.
Should we see an ENT first?
Sometimes. If the nose is persistently blocked or there is significant snoring, an ENT opinion may be the more useful starting point. Your GP or paediatrician can advise, and so can we.
Is it worth a second opinion?
If you are unsure about advice you have been given, yes. A good assessment should explain its reasoning, not just its conclusion.
What to do next
Book an assessment — including if you simply want to understand what is going on before deciding anything.
This guide is general information and does not replace an individual assessment. Your child’s clinician will confirm what is appropriate for them.